California Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in Nevada
|
|
- Ross Murphy
- 8 years ago
- Views:
Transcription
1 Non- Choice of Providers Calendar Year Deductible *The Fund s Calendar Year Deductible is never waived. However, some services are not subject to the Deductible. If you live in Nevada, your network of hospitals and doctors is the National BlueCard network. Participants who use a Contract physician, hospital, or other provider will pay the least for services. Individual: $250* Family: $750* Does not apply to hearing exam, hearing aids, hospice, and prescription drugs. If you use a physician or other Provider who is not in the Contract Provider Network, you are using a Non-Contract (or Non-Contracting) Provider. Participants who use a Non-Contracting physician, hospital, or other provider; will pay more for services. Individual: $500* Family: $1,500* Does not apply to hearing exam, hearing aids, hospice, and prescription drugs. In addition, balance billing and excluded services do not count toward either deductible. Participants must go to a Health Plan of Nevada provider and each family member may choose a different primary physician Not Applicable Lifetime Maximum $1,000,000 $1,000,000 Not Applicable Annual Out-Of-Pocket Maximum Individual: $2,000 Family: $6,000 Certain expenses do not count towards the Outof-Pocket Maximum. For more information, see your Summary Plan Description. None Your out-of-pocket expenses for services received at Non-Contract Providers are unlimited. Not Applicable Contract Rate & Allowable Charges Contract Rate: The amount that the Provider has agreed by contract to accept for the services provided. Allowable Charges: For Non-Contract Providers, the Allowable Charge is the lesser of the charge billed by the Provider or the maximum amount the Board of Trustees has determined is an appropriate payment for the service(s) rendered. Not Applicable For Non-Contract Providers, the Plan generally pays 60% of the Allowable Charges. You are generally responsible for 40% of the Allowable Charges plus any charges over the Plan s Allowable Charge. NOTE: Providers charges are often higher than the Plan s Allowable Charge. You are responsible for any charges above the Plan s Allowable Charge. 1 ǀ Page
2 Non- Pre-Authorization & Pre-Certification Requirements Description/Definition of Co-payment & Co-insurance Emergency Room and ER Physicians Charges Certain services and procedures require pre-authorization from Pacific Health Alliance ( PHA ) or from Anthem. If you fail to obtain pre-authorization or pre-certification when it is required, the Plan s payment percentage will be reduced by 10%, and you will be responsible for an additional 10% coinsurance. Inpatient hospitalization (except for emergencies and childbirth) requires pre-certification by Anthem (800) Outpatient surgeries and procedures, and various other services, require preauthorization from PHA (855) See the Evidence of Coverage booklet provided by. Co-payments are fixed dollar amounts (for example, $20) you pay for covered health care, usually when you receive the service. Co-insurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. 80% of Contract Rate 60% of Allowed Charges 100% after a $75 co-payment (waived if admitted) Emergency Ground Ambulance 80% of Contract Rate; 80% of Allowed Charges; 100% after a $50 co-payment Urgent Care 80% of Contract Rate; ; 100% after a $15 co-payment Skilled Nursing Facility * Not subject to the Out-of-Pocket Maximum. 45% of Contract Rate up to 55 days per disability and admission must occur after a 5-day or more inpatient hospital stay; patient must be admitted to the SNF within 7-days of the hospital discharge; * 35% of Allowable Charges up to 55 days per disability and admission must occur after a 5-day or more inpatient hospital stay; patient must be admitted to the SNF within 7-days of the hospital discharge; * $100 co-payment per day up to a maximum co-payment of $200 per admission and up to 100 days per calendar year Home Health Care 80% of Contract Rate Deductible Applies Deductible Applies Physician: 100% after a Private Duty Nurse: no co-payment and requires pre-authorization Inpatient Hospital (including Physician Services) To Pre-Certify your hospital stay, call Anthem Blue Cross at (800) % of Contract Rate Pre-certification by Anthem Blue Cross required. Pre-certification by Anthem Blue Cross required. $100 co-payment per day up to a maximum co-payment of $200 per admission Physician: $100 co-payment per surgery Anesthesia: $150 co-payment per surgery 2 ǀ Page
3 Non- Physician Office Visits 80% of Contract Rate; 60% of Allowed Charges; 100% after a $10 co-payment Physician Home Visits 80% of Contract Rate; 60% of Allowed Charges; 100% after a X-ray and Lab Services 80% of Contract Rate; 60% of Allowed Charges; Routine: Podiatry Exam 80% of Contract Rate; 60% of Allowed Charges; 100% after a $10 co-payment; prior authorization required Orthotic Appliances Chiropractic and Acupuncture Services 80% of Contract Rate up to a maximum benefit of $2,000 per calendar year* * The $2,000 maximum is a combined annual limit for all contract and non-contract chiropractic and acupuncture services. up to a maximum benefit of $2,000 per calendar year* * The $2,000 maximum is a combined annual limit for all contract and non-contract chiropractic and acupuncture services. $500 per device up to a maximum lifetime benefit of $10,000 Chiropractic: 100% after a $10 co-payment Prior authorization is required Acupuncture: Outpatient Surgery (Facility Fee) 80% of Contract Rate; Pre-authorization required by calling Pacific Health Alliance (PHA) Care Counseling service at (855) Maximum benefit of $350 per day; You are responsible for any charges in excess of the Plan s maximum payment of $350 per day. 100% after a $50 co-payment per surgery for facility 100% after a $50 physician surgical services Anesthesia: $150 per surgery Pre-authorization required by calling Pacific Health Alliance (PHA) Care Counseling service at (855) Physician/Surgeon Fee for Outpatient Surgery 80% of Contract Rate; Pre-authorization by PHA required. ; Pre-authorization by PHA required. 100% after a $50 co-payment per surgery for facility 100% after a $50 physician surgical services Anesthesia: $150 per surgery 3 ǀ Page
4 Non- Complex Imaging (MRI, PET & CT scans) 80% of Contract Rate; ; 100% after a $40 co-payment (PET Scan $750 per test) Physical Therapy & Respiratory Therapy, Combined Speech Therapy & Occupational Therapy, Combined Medical Supplies, Orthopedic Braces, Prosthetic Appliances 80% of Contract Rate up to a maximum benefit of $2,000 per calendar year Pre-authorization by PHA required. Only covered if the case manager determines that speech/occupational therapy is medically necessary 80% of Contract Rate Pre-authorization from PHA is required for equipment/ supplies costing over $500. up to a maximum benefit of $2,000 per calendar year Pre-authorization by PHA required. Only covered if the case manager determines that speech/occupational therapy is medically necessary Pre-authorization from PHA is required for equipment/ supplies costing over $ % after a $10 co-payment; Limitations apply All short term rehab is subject to a maximum benefit of 60 days / visits per member per calendar day 100% after a $10 co-payment Limitations apply DME: $100 or 50% of EME of purchase price or rental price whichever is less. Prosthetics & Orthotic Devices: $500 per device up to a maximum lifetime benefit of $10,000 including repairs Medical Supplies: No charge Chemotherapy/Radiation 80% of Contract Rate; ; $40 per day in addition to office visit co-pay Family Planning Infertility $40 co-payment / consultation only Vasectomy (reversal is not covered) 80% of Contract Rate; ; 100% (covered under preventive services) Tubal Ligation (reversal is not covered) 80% of Contract Rate; ; $100 co-payment for inpatient facility Elective Abortions 80% of Contract Rate; ; 4 ǀ Page
5 Non- Care for Allergies Office Visit 80% of Contract Rate; ; 100% after a $10 co-payment Testing 80% of Contract Rate; ; 100% after a $10 co-payment Treatment and Serum 80% of Contract Rate; ; 100% after a $10 co-payment Immunizations Covered under routine care and preventive healthcare Covered under routine care and preventive healthcare Hearing Care Exams 100% of Contract Rate up to a maximum benefit of $100 per calendar year* Deductible does not apply 100% of Allowable Charges up to a maximum benefit of $100 per calendar year Deductible does not apply 100% after a $10 co-payment Exam only Hearing Aids 100% of Allowed Amount (Allowed Amount is limited to $2,000 per device)*; limited to coverage once every three years from the date of last purchase** Deductible does not apply 100% of Allowed Amount (Allowed Amount is limited to $2,000 per device)*; limited to coverage once every three years from the date of last purchase** Deductible does not apply $100 or 50% of EME, whichever is less. Limited to a maximum benefit of $5,000 per member per calendar year & further limited to a single purchase, repairs & replacements limited to once every 3 years. *Charges applied to the $100 calendar year maximum are the combined total of PPO and Non-PPO charges for hearing exams *Charges applied to the $100 calendar year maximum are the combined total of PPO and Non-PPO charges for hearing exams ** Charges applied to the maximum Allowed Amount of $2,000 per device are the total of all contract and non-contract charges for hearing aid devices. **Charges applied to the $2,000 maximum are the combined total of PPO and Non-PPO charges for hearing aid devices. Hospice 100% of Contract Rate Limitations apply; refer to Plan SPD Deductible Does Not Apply 100% of Allowed Charges Limitations apply; refer to Plan SPD Deductible Does Not Apply Inpatient: $100 co-payment per day up to a maximum co-payment of $200 per admission for outpatient respite care up to a maximum benefit of $1,000 per calendar year 5 ǀ Page
6 Non- Routine Health Exams Preventative Health Care 80% of Contract Rate up to a maximum benefit of $300 per calendar year*; Deductible Applies 60% of Allowed Charges up to $300 per calendar year*; Deductible Applies 100% after a $10 co-payment No charge for preventive care *Charges applied to the $300 calendar year maximum are the combined total of PPO and Non- PPO charges for routine preventive health care. Charges for immunizations are included in routine preventive care *Charges applied to the $300 calendar year maximum are the combined total of PPO and Non- PPO charges for routine preventive health care. Charges for immunizations are included in routine preventive care Routine Female Care Examinations 80% of Contract Rate*; Deductible Applies 60% of Allowed Charges*; Deductible Applies 100% after a $10 co-payment diagnostic visit (Preventive Care Services) Pap Tests 80% of Contract Rate*; Deductible Applies 60% of Allowed Charges*; Deductible Applies (Preventive Care Services) Mammogram 80% of Contract Rate*; Deductible Applies 60% of Allowed Charges*; Deductible Applies (Preventive Care Services) * The combined maximum benefit for all PPO and Non-PPO charges for routine female care is limited to $300 per calendar year *The combined maximum benefit for all PPO and Non-PPO charges for routine female care is limited to $300 per calendar year Well Baby/Child Care 80% of Contract Rate up to a $600 per calendar year maximum benefit*; Deductible Applies 60% of Allowed Charges up to a $600 per calendar year maximum benefit*; Deductible Applies (Preventive Care Services) *Charges applied to the $600 calendar year maximum are the combined total of PPO and Non- PPO charges for well baby care and immunizations *Charges applied to the $600 calendar year maximum are the combined total of PPO and Non- PPO charges for well baby care and immunizations Substance Abuse Inpatient $100 co-payment per day up to a maximum copayment of $200 per admission Outpatient 100% after a $10 co-payment per visit 6 ǀ Page
7 Non- Mental Health Inpatient $100 co-payment per day up to a maximum co-payment of $200 per admission Outpatient Supplemental Accident Benefit Not Applicable 100% of Allowable Charges incurred within 90- days of an accident up to $300 for medical and $100 for X-ray and lab services per accident; documentation must be provided to the Trust Fund Office. Deductible does not apply 100% after a $10 co-payment per visit Charges remaining after the supplemental accident benefit has been paid will be subject to normal Plan provisions for Non-PPO claims including coinsurance levels, calendar year deductible, and other applicable Plan provisions. Vision Care Vision Service Plan (VSP) Frequency Exam Glasses/Contact Lenses Spectera/UnitedHealthcare Vision Frequency Customer Service: (800) Exam and glasses (or contact lenses) are available every 12 months $25 co-payment $150 allowance Customer Service (800) Exam and lenses are available every 12 months, frame is available every 24 months. VSP and Spectera provide limited reimbursement, according to a schedule of allowances for exams and materials. Please contact your vision plan for more information. Exam: $10 co-payment Glasses/Contact Lenses: Additional benefits available through either Vision Service Plan or Spectera Vision for an additional premium amount; See Fee-For- Service Benefits Exam Glasses/Contact Lenses $10 co-payment each for exam and materials $130 allowance ($105 for contacts) 7 ǀ Page
8 Non- PLEASE NOTE: If you are enrolled in the Plan and you are not participating in the Reinforcing Smart Choices Program (i.e. you and your covered spouse (or domestic partner) have not obtained a biometric screening or have not submitted your Participant Promise), then you will be in the BASIC PLAN and will be subject to the increased prescription drug co-payments effective January 1, Prescription Drug Coverage Retail 30-day Supply Generic Formulary Premier Plan: $10 co-pay Basic Plan: $15 co-pay Not Covered; limited exceptions for emergency prescriptions $6 co-payment Formulary Brand Name Premier Plan: $20 co-pay Basic Plan: $35 co-pay Not Covered; limited exceptions for emergency prescriptions $12 co-payment Non-Formulary Brand Name or Generic unless Pre-authorization is obtained. If preauthorized, paid as a formulary drug Not Covered; limited exceptions for emergency prescriptions Not applicable Mail Order 90-day Supply Generic Formulary Premier Plan: $20 co-pay Basic Plan: $30 co-pay Not Covered; limited exceptions for emergency prescriptions $12 co-payment Formulary Brand Name Premier Plan: $40 co-pay Basic Plan: $70 co-pay Not Covered; limited exceptions for emergency prescriptions $24 co-payment Non-Formulary Brand Name or Generic unless pre-authorization is obtained. If pre-authorized, paid as a formulary drug. Not Covered Not applicable 8 ǀ Page
9 Medicare Retired Participants Residing in Nevada For Medicare Retirees Choice of Providers Participants can use any provider; however, in order to receive the higher PPO Plan benefits, services must be received from an Anthem Blue Cross contracted provider. Medicare pays primary. Non- Services received from a non- Anthem Blue Cross provider are subject to the non-ppo level of benefits which could result in higher out-of-pocket expenses. Medicare pays primary. Senior Dimensions Choice Plus Participants must go to a Health Plan of Nevada Senior Dimensions provider and each family member may choose a different primary physician UnitedHealthcare Secure Horizons Participants must go to a UnitedHealthcare Secure Horizons provider and each family member may choose a different primary physician Calendar Year Deductible Not applicable Not applicable Not applicable Not applicable Lifetime Maximum Not applicable Not applicable Not applicable Not applicable Annual Out of Pocket Maximum $600 per person $1,800 per person $2,500 per person $1,800 per person Inpatient Hospital (including Physician Services) $250 co-payment per admit 60% of Allowed Charges $100 co-payment per admit Emergency Room & ER Physicians Charges Emergency Ground Ambulance Skilled Nursing Facility * Not subject to the Out-of-Pocket Maximum. 90% of Allowed Amount after a $100 co-payment; Waived if admitted 90% of Allowed Amount after a $50 co-payment 45% of Allowed Amount up to 55 days per disability and admission must occur after a 5-day or more inpatient hospital stay; patient must be admitted to the SNF within 7-days of the hospital discharge* 90% of Allowed Charges after a $100 co-payment; Waived if admitted 90% of Allowable Charges after a $50 co-payment 35% of Allowable Charges up to 55 days per disability and admission must occur after a 5-day or more inpatient hospital stay; patient must be admitted to the SNF within 7-days of the hospital discharge* $25 co-payment $50 co-payment Waived if admitted Days 1-20: Days : $25 co-payment $50 co-payment Days 1-20: Days : $25 co-payment Home Health Care 90% of Allowed Amount 60% of Allowed Charges per Medicare guidelines 9 ǀ Page
10 Medicare Retired Participants Residing in Nevada For Medicare Retirees Physician Office/Home Visits 90% of Allowed Amount after a Non- after a Senior Dimensions Choice Plus UnitedHealthcare Secure Horizons HMO Plan Benefits $5 co-payment Primary Care: $5 co-payment Specialist: Hospice 100% of Allowed Amount 100% of Allowable Charges Covered under Medicare X-ray and Lab 90% of Allowed Amount Outpatient Surgery 90% of Allowed Amount Ambulatory Surgical Centers are limited to a maximum benefit of $350 per day; $50 co-payment per surgery Podiatry Exam 90% of Allowed Amount after a after a $15 co-payment up to 4 self referrals per calendar year Orthotic Appliance 90% of Allowed Amount Maximum benefit payable is 20% of Medicare approved charges Per Medicare guidelines Chiropractic and Acupuncture Chiropractic 90% of Allowed Amount $15 co-payment 50%; Limited to 12 visits per calendar year Acupuncture Outpatient Physical, Respiratory and Speech Therapy 90% of Allowed Amount 90% of Allowed Amount $15 co-payment Limitations apply Routine Preventative Care Exams 100% of Allowed Amount with no maximum calendar year benefit 60% of the Allowable Charges up to a maximum calendar year benefit of $300 Limitations apply Immunizations 100% of Allowed Amount 10 ǀ Page
11 Medicare Retired Participants Residing in Nevada For Medicare Retirees Non- Senior Dimensions Choice Plus UnitedHealthcare Secure Horizons Periodic Female Care Examinations 100% of Allowed Amount with no maximum calendar year benefit 60% of Allowabled Charges up to a maximum calendar year benefit of $300 Pap Tests/Mammogram 100% of Allowed Amount with no maximum calendar year benefit up to a maximum calendar year benefit of $300 Care for Allergies Office Visit/Testing 90% of Allowed Amount after a after a $20 co-payment $5 co-payment/ $10 co-payment Treatment and Serum 90% of allowed amount $10 co-payment Durable Medical Equipment Prosthetics 90% of allowed amount $0 co-payment except for insulin pumps & associated supplies than 20% of Medicare approved charges 20% Orthopedic Braces 90% of allowed amount 20% of Medicare approved charges Other equipment and supplies 90% of allowed amount Hearing Care Exams 100% of Allowed Amount up to a maximum benefit of $100 per calendar year 100% of Allowable Charges up to a maximum benefit of $100 per calendar year Up to 40% discount with Plan providers Hearing Aids 100% of Allowed Amount (Allowed Amount is limited to $2,000 per device)*; limited to coverage once every three years from the date of the last purchase. Your payments made towards allowable charges above the cap do not apply towards your out-ofpocket maximum. 100% of Allowed Amount (Allowed Amount is limited to $2,000 per device)*; limited to coverage once every three years from the date of the last purchase. Your payments made towards allowable charges above the cap do not apply towards your out-of-pocket maximum. See Medicare Retiree $500 allowance for every 36 months 11 ǀ Page
12 Medicare Retired Participants Residing in Nevada For Medicare Retirees Non- Senior Dimensions Choice Plus UnitedHealthcare Secure Horizons HMO Plan Benefits Substance Abuse Inpatient $100 co-payment per admit Outpatient $15 co-payment Individual: Group: $5 co-payment Mental Health Inpatient $100 co-payment per admit Limited to 190-days per lifetime Outpatient $15 co-payment Individual: Group: $5 co-payment Vision Care Vision Service Plan (VSP) Frequency Exam Customer Service: (800) Exam and glasses (or contact lenses) are available every 12 months $25 co-payment VSP and Spectera provide limited reimbursement, according to a schedule of allowances for exams and materials. Please contact your vision plan for more information. Vision benefits available through either Vision Service Plan or Spectera Vision for an additional premium amount; See Benefits Exam: (includes glaucoma testing) Glasses/Contact Lenses: $75 allowance (Medicare covered after a cataract surgery) Covered in lieu of glasses Glasses/Contact Lenses Spectera/UnitedHealthcare Vision Frequency $150 allowance Customer Service (800) Exam and lenses are available every 12 months, frame is available every 24 months. Additional benefits available through either Vision Service Plan or Spectera Vision for an additional premium amount; See Fee-For- Service Benefits Exam $10 co-payment each for exam and materials Glasses/Contact Lenses $130 allowance ($105 for contacts) 12 ǀ Page
13 Medicare Retired Participants Residing in Nevada For Medicare Retirees Prescription Drugs Retail 30 days supply Non- Senior Dimensions Choice Plus 31 days supply UnitedHealthcare Secure Horizons Generic $10 co-payment for preferred generic $6 co-payment for non-preferred generic See benefits Preferred Brand Name $35 co-payment See benefits Non-Preferred Brand Name $40 co-payment $60 co-payment See benefits Mail Order 90 days supply 90 days supply Generic for preferred generic $6 co-payment for non-preferred generic See benefits Preferred Brand Name $40 co-payment $35 co-payment See benefits Non-Preferred Brand Name $80 co-payment See benefits 13 ǀ Page
14 Medicare and (additional premium required for all plans) Choice of Providers Calendar Year Deductible Maximum Calendar Year Benefit Diagnostic, Preventative, Basic and Major Covered Services Orthodontia DENTAL BENEFITS Dental Plan Participants can visit any licensed dentists, however costs are lowest when visiting a Delta Dental PPO Dentist. If participants do not choose to use a Delta Dental PPO Dentist, they still have access to a Delta Dental Premier Dentist. You may pay more when seeing a Premier dentist than a PPO dentist, but still have cost protections that are not available when visiting a non-delta Dental dentist. Delta Dental Customer Service: (800) $50 per person $150 per family PPO network: $3,000 per person Premier network: $2,000 per person Out-of-network: $1,500 per person Limits do not apply to pediatric dental services to age 19 PPO network: 100% for Diagnostic & Preventative, Basic and Major services based on Delta Dental PPO contracted fees Premier network: 100% for Diagnostic & Preventative; 80% for Basic and Major services based on Delta Dental Premier contracted fees Out-of-Network: 80% for Diagnostic & Preventative; 50% for Basic and Major services based on Delta standard non-par reimbursement for non-delta Dental dentists Plan pays 50% of Delta Dental PPO contracted fees up to a lifetime maximum of $1,000 for dependent children only. DeltaCare USA HMO Dental Plan Participants must use an authorized DeltaCare USA HMO Dental Provider DeltaCare USA Customer Service: (800) Not Applicable No Maximum All services must be pre-authorized and referrals are necessary for specialized treatments. Please refer to the enrollment packet for specific co-payment information Members must receive all services from their assigned DeltaCare USA provider. Orthodontic Extractions: $0-$90 co-payment Enrollee Cost (Comprehensive Adult Treatment): $1,900 co-payment Enrollee Cost (Comprehensive Child Treatment): $1,700 co-payment Orthodontic Takeover Covered 14 ǀ Page
KAISER PERMANENTE PLAN (Non-Medicare Eligible)
CEMENT MASONS HEALTH AND WELFARE TRUST FUND FOR NORTHERN CALIFORNIA RETIRED CEMENT MASONS AND THEIR ELIGIBLE DEPENDENTS EFFECTIVE JANUARY 1, 2015 GENERAL When You Can Change Plans Type of Plan, Service
More informationWhen You Can Change Plans. Care is provided through physicians or medical staff at a Kaiser Permanente facility located in the member's service area.
CEMENT MASONS HEALTH AND WELFARE TRUST FUND ACTIVE CEMENT MASONS AND THEIR ELIGIBLE DEPENDENTS EFFECTIVE FEBRUARY 1, 2013 PLAN FEATURES DIRECT PAYMENT PLAN KAISER PERMANENTE When You Can Change Plans Type
More informationOPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES
PPO Kaiser Permanente For Non-PPO Providers Employee Premium None None None None None Explanation of s and Options Available to You If you choose a doctor who is not contracted with Anthem Blue Cross the
More informationCarpenters Health & Welfare Trust Fund for California Retiree Plan Comparison
Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison Information Needed: Eligibility, Benefits, COBRA or Disability Claims: Indemnity Medical Plan Indemnity Hearing Aid Benefit
More informationOperating Engineers Public Employees Health and Welfare Trust Fund Plan D vs PERS CHOICE and PERS SELECT PPO Plan
Calendar Year Deductible $500 Individual / $1,000 Family per calendar year Does not apply to PPO physician office visits, PPO preventive care or hospital emergency room charges for an emergency medical
More informationLOCKHEED MARTIN AERONAUTICS COMPANY PALMDALE 2011 IAM NEGOTIATIONS UNDER AGE 65 LM HEALTHWORKS SUMMARY
Annual Deductibles, Out-of-Pocket Maximums, Lifetime Maximum Benefits Calendar Year Deductible Calendar Year Out-of- Pocket Maximum Lifetime Maximum Per Individual Physician Office Visits Primary Care
More informationOPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS
Employee Premium None None None None None Explanation of Plans and Options Available to You Deductible Annual Out-of-Pocket Calendar Year (Applicable to members who reside in California & Nevada Only.)
More informationROCHESTER INSTITUTE OF TECHNOLOGY 2014 Medical Benefits Comparison Chart Medicare-Eligible Retirees in the Rochester Area
Contacting the Carrier Voice: (877) 883-9577 TTY: (585) 454-2845 Website: Voice: (800) 665-7924 TTY: (800) 252-2452 Website: www.excellusbcbs.com www.mvphealthcare.com Deductible Carry Over None None Deductible,
More informationBenefits At A Glance Plan C
Benefits At A Glance Plan C HIGHLIGHTS OF WELFARE FUND BENEFITS WELFARE FUND BENEFITS IN BRIEF Medical and Hospital Benefits Empire BlueCross BlueShield Plan C-1 Empire BlueCross BlueShield Plan C-2 All
More informationHealth Plans Comparison Chart
Health Plans Comparison Chart PPO Deductible Coinsurance (Plan pays) Annual Out-of-Pocket Maximum (Medical) (all medical s, deductibles and coinsurance for covered services will apply. Once limit is met,
More informationSUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015
SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective General Services In-Network Out-of-Network Physician office visit Urgent care
More informationBenefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015
Benefit Coverage Chart & Rates Effective PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits o Dental o Dental & Orthodontia
More informationS c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15
S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15 This information sheet is for reference only. Please refer to Evidence of Coverage requirements, limitations
More informationSUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective 1/1/2015
SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective General Services In-Network Out-of-Network Primary care physician You pay $25 copay per visit Physician office
More informationS c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16
S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16 This information sheet is for reference only. Please refer to Evidence of Coverage requirements, limitations
More informationBRYN MAWR COLLEGE MEDICAL INSURANCE BENEFITS COMPARISON EFFECTIVE NOVEMBER 1, 2009
BENEFITS Description of Plan Annual Deductible (January - December) - Individual - Family PERSONAL CHOICE PPO BRYN MAWR COLLEGE KEYSTONE HEALTH PLAN EAST KEYSTONE POS Provides comprehensive health Provides
More informationBenefit Coverage Chart & Rates
Benefit Coverage Chart & Rates Effective July 1, 2014- June 30, 2015 PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits
More informationKraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan
General Provisions Deductible (eligible medical and prescription drug expenses apply to the deductible) Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary Care can be obtained in-network
More informationRETIRED LABORERS HEALTH AND WELFARE PLAN - COMPARISON OF BENEFITS - EFFECTIVE SEPTEMBER 1, 2015 LABORERS
When You Can Change Plans Type of Plan Geographical Area Covered Choice of Physicians Specialized Care: In-Network Outside Network Out-of-Area Care Claim Forms Annual Deductible RETIRED HEALTH AND WELFARE
More informationLEGACY PLAN Medical In-Ntwk Out-of-Ntwk
Preventive Services Age, gender and frequency criteria Adult physical/immunizations Well child visits/immunizations Screenings 0 Co-Insurance (after deductible) Out-of-Pocket Maximums Office Visit (copays)
More informationService AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network
2016 Medicare Advantage Plans Comparison Chart This comparison chart is a side-by-side representation of services offered through the AvMed, Cigna, UHC, and Humana Medicare Advantage Plans for both in-network
More informationSummary of Benefits and Coverage What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers
More informationYour Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO
Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does
More informationFee-for-Service. Medicare Supplemental Retiree Health Plans
Sheet Metal Workers Health Plan of Southern California, Arizona & Nevada April 2011 Summary Comparison Of Benefits Available under the Fee-for-Service and Medicare Supplemental Retiree Health Plans Important:
More information2015 Medical Plan Summary
2015 Medical Plan Summary AVMED POS PLAN This Schedule of Benefits reflects the higher provider and prescription copayments for 2015. This is not a contract, it s a summary of the plan highlights and is
More informationPLAN DESIGN AND BENEFITS - PA Health Network Option AHF HRA 1.3. Fund Pays Member Responsibility
HEALTHFUND PLAN FEATURES HealthFund Amount (Per plan year. Fund changes between tiers requires a life status change qualifying event.) Fund Coinsurance (Percentage at which the Fund will reimburse) Fund
More informationCarpenters Health & Welfare Trust Fund for California
Carpenters Health & Welfare Trust Fund for California Comparison for Plan B & Flat Rate Benefits Information Needed: Eligibility, Benefits, COBRA, Disability, or Life and Accidental Death and Dismemberment
More informationLesser of $200 or 20% (surgery) $10 per visit. $35 $100/trip $50/trip $75/trip $50/trip
HOSPITAL SERVICES Hospital Inpatient : Paid in full, Non-network: Hospital charges subject to 10% of billed charges up to coinsurance maximum. Non-participating provider charges subject to Basic Medical
More informationPLAN DESIGN AND BENEFITS POS Open Access Plan 1944
PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being
More informationAVMED POS PLAN. Allergy Injections No charge 30% co-insurance after deductible Allergy Skin Testing $30 per visit 30% co-insurance after deductible
AVMED POS PLAN This Schedule of Benefits reflects the higher provider and prescription copays for 2015. This is not a contract, it s a summary of the plan highlights and is subject to change. For specific
More informationStudentBlue University of Nebraska
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO What is the overall deductible? This is only a summary. If you want more details about
More informationPace University CIGNA Medical Detailed Benefit Summaries July 1, 2015 - June 30, 2016
Consumer Core HDHP In Net $50 (ONLY APPLICABLE TO THOSE Network Core $25 ALREADY ENROLLED) Network Choice Fund In Network In Network In Network Deductible $1,300/$2,600 (Cumulative) N/A N/A Coinsurance
More informationCost Sharing Definitions
SU Pro ( and ) Annual Deductible 1 Coinsurance Cost Sharing Definitions $200 per individual with a maximum of $400 for a family 5% of allowable amount for inpatient hospitalization - or - 50% of allowable
More informationSummary of Benefits and Coverage What this Plan Covers & What it Costs - 2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers
More informationPPO Schedule of Payments (Maryland Large Group) Qualified High Deductible Health Plan National QA2000-20
PPO Schedule of Payments (Maryland Large Group) Qualified High Health Plan National QA2000-20 Benefit Year Individual Family (Amounts for Participating and s services are separated in calculating when
More informationYour Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO
Your Plan: Value HMO 25/40/20% (RX $10/$30/$45/30%) Your Network: Select Plus HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary
More informationBlueSelect Silver ValueTwo for Individuals
BlueSelect Silver ValueTwo for Individuals Coverage Period: 1/1/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Single Plan Type: PPO This is only
More informationMedical Plan - Healthfund
18 Medical Plan - Healthfund Oklahoma City Community College Effective Date: 07-01-2010 Aetna HealthFund Open Choice (PPO) - Oklahoma PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY -
More informationYour Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO
Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does
More informationImportant Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
More information2015 Medical Plan Options Comparison of Benefit Coverages
Member services 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-800-464-4000 Web site www.anthem.com/ca/llns/ www.anthem.com/ca/llns/ www.anthem.com/ca/llns/ www.anthem.com/ca/llns/
More informationCalifornia Small Group MC Aetna Life Insurance Company
PLAN FEATURES Deductible (per calendar year) $1,000 per member $1,000 per member Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate
More informationInsurance Benefits For Employees C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S
CCPS Insurance Benefits For Employees 2015 C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S CHESTERFIELD COUNTY PUBLIC SCHOOLS BENEFITS DEPARTMENT Enrollment or Changes in Coverage 748-1226,
More informationWhat is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.
More informationNATIONAL HEALTH & WELFARE FUND PLAN C
H E A LT H A N N U I T Y I O N V A C AT P E N S I O N NATIONAL HEALTH & WELFARE FUND PLAN C BENEFITS AT A GLANCE Introduction The IATSE National Health & Welfare Fund was set up to provide health care
More informationCalifornia Small Group MC Aetna Life Insurance Company
PLAN FEATURES Deductible (per calendar year) $3,000 Individual $6,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. All covered expenses accumulate separately
More informationMotion Picture Industry (MPI) Active Health Plan Medical Plan Benefit Comparison At-A-Glance
Motion Picture Industry (MPI) Active Health Plan Medical Plan Benefit Comparison At-A-Glance Hospital Services Room and Board Intensive Care Ancillary Services Semi-Private Room Extended Care Room and
More informationCoverage level: Employee/Retiree Only Plan Type: EPO
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan documents at www.dbm.maryland.gov/benefits or by calling 410-767-4775
More informationImportant Questions Answers Why this Matters:
Anthem Blue Cross Life and Health Insurance Company Unify: PPO Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family
More informationIndependent Health s Medicare Passport Advantage (PPO)
Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary
More informationBlue Cross Premier Bronze Extra
An individual PPO health plan from Blue Cross Blue Shield of Michigan. You will have a broad choice of doctors and hospitals within Blue Cross Blue Shield of Michigan s unsurpassed statewide PPO network
More informationWhat is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
More informationMedical Plan Comparison - Retirees Age 65 or Over
* Plan Type Medicare Cost Plan with Prescription Coordinates with Medicare and includes Medicare prescription drug program Medicare Cost Plan with Prescription Medicare Advantage Plan with Prescription
More informationInternational Student Health Insurance Program (ISHIP) 2014-2015
2014 2015 Medical Plan Summary for International Students Translation Services If you need an interpreter to help with oral translation services, you may contact the LifeWise Customer Service team at 1-800-971-1491
More informationHealth Insurance Matrix 01/01/16-12/31/16
Employee Contributions Family Monthly : $121.20 Bi-Weekly : $60.60 Monthly : $290.53 Bi-Weekly : $145.26 Monthly : $431.53 Bi-Weekly : $215.76 Monthly : $743.77 Bi-Weekly : $371.88 Employee Contributions
More informationSMALL GROUP PLAN DESIGN AND BENEFITS OPEN CHOICE OUT-OF-STATE PPO PLAN - $1,000
PLAN FEATURES PREFERRED CARE NON-PREFERRED CARE Deductible (per calendar year; applies to all covered services) $1,000 Individual $3,000 Family $2,000 Individual $6,000 Family Plan Coinsurance ** 80% 60%
More informationThis is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
BlueCross BlueShield Healthcare Plan of Georgia Premier Plus POS Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2013-01/01/2014 Coverage For: Individual/Family
More informationPLAN DESIGN AND BENEFITS - Tx OAMC Basic 2500-10 PREFERRED CARE
PLAN FEATURES Deductible (per calendar year) $2,500 Individual $4,000 Individual $7,500 Family $12,000 Family 3 Individuals per Family 3 Individuals per Family Unless otherwise indicated, the Deductible
More informationLGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-800-870-3057. Important Questions
More informationBoston College Student Blue PPO Plan Coverage Period: 2015-2016
Boston College Student Blue PPO Plan Coverage Period: 2015-2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: PPO This is only a
More informationSummary of Benefits Community Advantage (HMO)
Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
More informationImportant Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
Gold 80 PPO Network Name: Exclusive Coverage Period: Beginning on or after 1/1/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan Type:
More informationImportant Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Summary Plan Description (SPD) or Plan Document at www.pebtf.org or by calling 1-800-522-7279.
More informationMAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF BENEFITS
Fiscal Year 2015 2016 MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF S ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
More informationImportant Questions Answers Why this Matters:
HealthKeepers Anthem HealthKeepers 20 POS / $10/$20/$35/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family
More information100% Fund Administration
FUND FEATURES HealthFund Amount $500 Employee $750 Employee + Spouse $750 Employee + Child(ren) $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at which the Fund
More informationBlue Care Elect Preferred 90 Copay Coverage Period: on or after 09/01/2015
Blue Care Elect Preferred 90 Copay Coverage Period: on or after 09/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Only Plan Type: PPO This is only
More informationPLAN DESIGN AND BENEFITS - Tx OAMC 1500-10 PREFERRED CARE
PLAN FEATURES Deductible (per calendar year) $1,500 Individual $3,000 Individual $4,500 Family $9,000 Family 3 Individuals per Family 3 Individuals per Family Unless otherwise indicated, the Deductible
More informationMassachusetts Laborers' Health Fund: Plan A Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Massachusetts Laborers' Health Fund: Plan A Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage for: Individual + Family Plan Type: PPO
More informationSummary of PNM Resources Health Care Benefits Active Employees 2011
of PNM Resources Health Care Benefits Active Employees 2011 The following charts show deductibles, limits, benefit levels and amounts for the PNM Resources medical, dental and vision programs. For more
More informationPLAN DESIGN AND BENEFITS AETNA LIFE INSURANCE COMPANY - Insured
PLAN FEATURES Deductible (per calendar year) Individual $750 Individual $1,500 Family $2,250 Family $4,500 All covered expenses accumulate simultaneously toward both the preferred and non-preferred Deductible.
More informationHealth Alliance Plan. Coverage Period: 01/01/2014-12/31/2014. document at www.hap.org or by calling 1-800-759-3436.
Health Alliance Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage for: Individual Family Plan Type: HMO This is only a summary.
More informationYou can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pekininsurance.com or by calling 1-800-371-9622. Important
More informationWhat is the overall deductible? Are there other deductibles for specific services?
: MyPriority POS RxPlus Silver 1800 Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Subscriber/Dependent Plan Type:
More informationSERVICES IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE
COVENTRY HEALTH AND LIFE INSURANCE COMPANY 3838 N. Causeway Blvd. Suite 3350 Metairie, LA 70002 1-800-341-6613 SCHEDULE OF BENEFITS BENEFITS AND PRIOR AUTHORIZATION REQUIREMENTS ARE SET FORTH IN ARTICLES
More informationImportant Questions Answers Why this Matters:
Minimum Coverage PPO Network Name: Exclusive Coverage Period: Beginning on or after 1/1/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan
More informationHEALTH CARE DENTAL CARE
UNIVERSITY OF DAYTON MEDICARE SUPPLEMENT PLAN OPEN ENROLLMENT HEALTH CARE DENTAL CARE 2016 Office of Human Resources 300 College Park Dayton, OH 45469-1614 Phone 937-229-2541 Fax 937-229-2009 O65 1 Health
More informationImportant Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gpatpa.com or by calling 915-887-3420. Important Questions
More informationCoverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bbsionline.com or by calling 1-866-927-2200. Important
More informationFCPS BENEFITS COMPARISON Active Employees and Retirees Under 65
FCPS S COMPARISON Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible None $250 None $250 None Family Annual Deductible Limit None $500 None $500 None
More informationWhat is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket
Regence BlueShield: Regence Direct Gold with Dental, Vision, Individual Assistance Program Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers & What
More informationPLAN DESIGN AND BENEFITS HMO Open Access Plan 912
PLAN FEATURES Deductible (per calendar year) $1,000 Individual $2,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member cost sharing for certain services
More informationImportant Questions Answers Why this Matters:
Anthem BlueCross Premier HMO 20 / $10/$25/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage For: Individual/Family Plan Type:
More informationYour Plan: Premier HMO 20/200A/100 OP Your Network: California Care HMO
Your Plan: Premier HMO 20/200A/100 OP Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does not reflect
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015
More informationUMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplanoperations@umchealthsystem.com or by calling
More informationEmployee + 2 Dependents
FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at
More informationHow Much Does Your Health Care Plan Cover?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.arml.org\benefit_programs.html or by calling 1-501-978-6137.
More informationComparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015
Comparison of Health Care Plans Metro Interagency Insurance Program Effective Date: July 1, 2015 Wellmark Blue Cross Blue Shield Customer Service: 1-800-277-8380 Participating Provider Directory Information:
More informationAnthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 Your Network: Prudent Buyer PPO
Anthem Blue Cross Life and Health Insurance Company Your Plan: Solution PPO 1500/15/20 Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with
More informationBlue Shield of California Life & Health Insurance: Active Start Plan 25 - G Coverage Period: Beginning on or after 1/1/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.blueshieldca.com or by calling 1-800-431-2809. Important
More informationAdministered by Capital BlueCross 1
Administered by Capital BlueCross 1 PPO HRA Plan/Rx Plan This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at
More informationPhysicians Plus Insurance Corporation Coverage Period: 01/01/2016 12/31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pplusic.com or by calling 1-800-545-5015. Important Questions
More informationBusiness Life Insurance - Health & Medical Billing Requirements
PLAN FEATURES Deductible (per plan year) $2,000 Employee $2,000 Employee $3,000 Employee + Spouse $3,000 Employee + Spouse $3,000 Employee + Child(ren) $3,000 Employee + Child(ren) $4,000 Family $4,000
More informationCalifornia PCP Selected* Not Applicable
PLAN FEATURES Deductible (per calendar ) Member Coinsurance * Not Applicable ** Not Applicable Copay Maximum (per calendar ) $3,000 per Individual $6,000 per Family All member copays accumulate toward
More informationAnthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60)
Anthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60) Summary of Benefits and Coverage: What this Plan Covers & What it Costs
More informationYou can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cvtrust.org or by calling 1-800-288-9870. Important Questions
More informationCompass Rose Health Plan: High Option Coverage Period: 01/01/2015 12/31/2015
This is only a summary. Please read the FEHB Plan RI 72-007 that contains the complete terms of this plan. All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB
More information